home Contributions Accident and illness insurance. Overview of insurance companies insuring civil servants Accident insurance for civil servants

Accident and illness insurance. Overview of insurance companies insuring civil servants Accident insurance for civil servants

Accident and illness insurance is one of the traditional types of insurance. The purpose of accident insurance is to compensate for damage caused to the health and life of the insured as a result of an accident.
Accident insurance has a long history and tradition. Its appearance is associated with the requirement contained in the 1541 Wisby maritime law (Great Britain) that the owners of ships should insure the life of the captain against accidents. In the seventeenth century, a report card (table) appeared in Holland in connection with the loss of various parts of the body for volunteer soldiers. And in the eighteenth, nineteenth, early twentieth centuries, this type became more and more common and in demand (in Germany, mutual aid unions were created in case of limb fractures, in England specialized insurance companies against accidents and bodily injuries began to be established, in Russia a law was adopted from 2 June 1903 "On the remuneration of victims of accidents of workers and employees, as well as members of their families in enterprises of the factory, mining and mining industry", which established the employer's liability for professional risk in the event of injury to workers or their death due to industrial accidents, etc.).
Almost a century later, thanks in large part to German insurance companies, there emerged and then fully manifested such a trend as the separation of accident insurance into a separate type of insurance. This requires some explanation: after all, for a long time this type of insurance protection was provided as part of life insurance - in the form of some option, additional coverage for the risk of death. In other words, such coverage was provided in relation to the risk of death, including as a result of an accident. At that time, it was possible to name only one basis that made it possible to single out accident insurance as a separate type of activity, and that such basis was associated not so much with the awareness of the specifics of this type of insurance, the features of insurance equipment in its implementation, but rather with the form of implementation this type of insurance. This was due to the establishment mandatory liability certain categories of entrepreneurs for the life and health of employees. Thus, various types of early manifestations of 294 have been developed.

compulsory insurance against accidents and diseases (at work, in transport, etc.).
The practice of accident insurance shows that it can be carried out in various forms, while maintaining a uniform socio-economic content.
Accident insurance may be compulsory or voluntary.
Compulsory insurance from accidents is one of the elements of the social insurance system and covers the risks of industrial injuries and occupational diseases.
This is a rather limited list of insured risks and amounts of insurance coverage, which, in the case of insurance against accidents at work, applies to the consequences of accidents occurring at the workplace or during working hours, including the time of travel to the place of performance of official functions and travel from the place work home. Insurance premiums paid in full by the employer.
Another type of compulsory accident insurance is the compulsory state insurance of life and health of those categories of civil servants whose professional activities are associated with an increased risk of an accident in their performance. official duties. These are military personnel, employees of internal affairs bodies, judges, bailiffs, employees of the tax police, employees of institutions and bodies of the criminal correctional system, etc.
State personal insurance covers the risks of death, disability of the insured as a result of injury, injury, bodily injury that occurred during the performance of the insured's official duties. Insurance coverage is established on the basis of the size of the official salary or on the basis of the amount of the minimum monthly wage.
The basics of compulsory state insurance of various categories of employees are enshrined in the relevant regulations:
a) Federal Law "On compulsory state insurance of life and health of military personnel, citizens called up for military training, private and commanding staff of internal affairs bodies Russian Federation, employees of institutions and bodies of the criminal correctional system and employees of federal tax police bodies”;
b) RF Law “On Militia”, Law “On Internal Troops of the Ministry of Internal Affairs of the Russian Federation”;
c) Law of the Russian Federation “On the Status of Judges in the Russian Federation”;
d) Law of the Russian Federation "On private detective and security activities in the Russian Federation" and others.
Compulsory accident insurance is also found in transport. Thus, compulsory personal insurance of passengers transported by air, rail, water and by car on intercity and tourist routes, is carried out in relation to the risks of death, injury, bodily injury resulting from an accident that occurred when following any of the listed modes of transport. The maximum sum insured to be paid in the event of the death of a passenger is fixed by law and amounts to 120 minimum

monthly wages and is calculated on the date of purchase of the travel document. In the event of an injury or injury, the amount of insurance coverage is calculated in proportion to the severity of the bodily injury or injury received as a result of the accident. The cost of insurance is included in the cost of the travel document.
The terms of the insurance contract, the methodology for calculating and economic justification for insurance rates, as well as the provision on the procedure for the formation of reserves for compulsory insurance of passengers are approved by the insurance supervisory authority, and then the rates are agreed with the Ministry of Transport and Communications of the Russian Federation. The allocation of compulsory personal insurance for passengers transported by air, rail, water and road is also quite often criticized. Many experts believe that in this way the typical risk of the responsibility of the carrier itself is transformed into the risk of the passenger himself, who entrusted his life and health to the transport carrier when purchasing a travel document. Adherents of this point of view believe that it would be more logical to fix the carrier's obligation to insure its liability for the life and health of passengers carried. This position is also confirmed in international practice. So, in foreign legislation, it is more typical to fix the carrier's civil liability to passengers, in connection with which the carrier is required to insure such liability.
Currently, voluntary accident and illness insurance also has several implementation models (individual and collective) and provides insured persons with insurance protection against economic consequences bodily injury, sudden illness, disability, death resulting from unforeseen and accidental events, qualifying as an accident.
In the classification of types of insurance activities given in the "Conditions for Licensing Insurance Activities in the Territory of the Russian Federation" dated March 19, 1994, it is the concept of "insurance against accidents and illnesses" that is used. It includes: “... a set of types of personal insurance that provide for the obligations of the insurer for insurance payments in a fixed amount or in the amount of partial or full compensation for the additional expenses of the insured person caused by the occurrence of an insured event (a combination of both types of payments is possible)”.
This suggests that along with the actual risk of an accident insurance cover may also include protection against various diseases, which in the traditional sense, although they are not an accident, are nonetheless caused by a sudden external impact on a person. Thus, using such an understanding of the disease in the conditions of this type of insurance, insurers actually equate such sudden effects on a person, manifested in the form of diseases, with an accident.
Thus, the most common definition of an accident is as follows: “Accident is any bodily injury or other violation of the internal or external functions of the body, identified by the place and time of occurrence and not dependent on the will of the insured, as well as other other causes not controlled by the insured and factors, if they are caused or received during the validity period of the insurance contract.
Thus, the principal criteria for classifying an incident as an accident in its broadest sense for insurance purposes (actual accident and illness) are:
a) the suddenness of the impact; at the same time, suddenness implies that the event should be relatively short-lived in terms of its harmful effect on the human body;
b) impact that does not depend on the will of the insured; in other words, they also talk about the unforeseen impact, that is, causing harm to the life and health of the insured (insured person) unintentionally, not at the will of the insured;
c) the impact is external; external influence is understood as the actions of people, as well as natural phenomena or mechanical influences that harm the anatomical and physiological integrity of a person;
d) impact identified by time and place of occurrence; this is an extremely important aspect for establishing the very fact of the occurrence of an insured event;
e) the impact, manifested in the violation of the internal or external functions of the body.
Quite often, insurers limit their liability only to the concept of "accident" in its literal sense, often equating it to bodily injury and injury, attributing the risk of illness as a result of sudden impacts as part of voluntary health insurance coverage. If the insurance organization follows a broad interpretation of the concept of an accident, then the scope of coverage may also include risks associated with disability.
At the same time, traditional foreign interpretations of the concepts of disability and the allocation of various types of disability were rather difficult to take root in Russian insurance practice. Enough long time Russian insurance companies operated exclusively with the concept of disability and distinguished various groups of disability based on the standards of medical reports related to the appointment of social pensions when establishing disability, since the most important criterion for establishing the fact of an insured event for this risk was the conclusion of the VTEK (now it is MSEK). Because of this, the insurer followed the scale of disability groups (1st, 2nd and 3rd), which was used by the medical authorities that assessed the patient's health status. With the introduction of changes in the standards of medical reports and the introduction of a more diversified scale in relation to changes (deterioration) in the health status of a citizen and insurers, it became possible to bring their practice closer to international standards and use in the rules of insurance, in the conditions of insurance contracts, in the standards for settling claims for insurance payments, the concepts of various types of disability.
The most common definitions of disability used in the practice of Russian insurance organizations are as follows:
Permanent complete loss of general ability to work - complete and absolute disability, which does not allow the insured person to engage in any work activity and which lasts until the end of his life.
Partial total disability - loss of limbs, vision, hearing, speech or smell. Thus, this type of disability is equated to a certain type of bodily injury or other impairment of bodily functions. Often in these cases, insurance coverage is provided in the form of insurance coverage according to the Benefit Table (examples of Benefit Tables are provided below).
Temporary disability (illness) - an inability determined by a doctor for health reasons to perform work for a relatively short period of time - up to three months, after which the patient must be sent for examination of the VTEK to determine the degree of loss of general ability to work.
In this case, bodily injury is understood as a violation of the physical integrity of the body or the disease of the insured, provided for in the tables of insurance payments, which occurred during the period of validity of the insurance contract as a result of an accident. Whereas illness implies any health disorder not caused by an accident, diagnosed for the first time on the basis of objective symptoms after the entry into force of the insurance contract. Although once again it must be emphasized that quite often insurers, when insuring against accidents and illnesses, associate the very fact of diagnosing a disease with an accident that happened earlier and caused the occurrence (manifestation) of the disease.
Quite often, insurers also distinguish the concept of loss of professional ability to work, which implies complete or partial disability, which does not allow the insured person to engage in his professional activities. At the same time, it is extremely important that the implementation of a particular activity is of a professional nature, which is confirmed by the availability of appropriate education, qualifications, skills, etc.
When using the concepts of different groups of disabilities for the purposes of insurance against accidents and diseases, the concept of a person in need of care is an important category. Persons requiring constant care are persons who, due to an objective state of health, cannot independently serve the physiological needs of the body and (or) need special medical (therapeutic, curative, diagnostic) care.
In the practice of insurance, various definitions (formulations) of disability are used, although they do not fundamentally differ in content. So, the most common are as follows:
a) disability - social insufficiency due to a health disorder with a persistent disorder of body functions, leading to a limitation of life and the need social protection, or a more general definition, nevertheless containing a link to the assessment (decision) of the relevant medical authority, namely:
b) disability - a state of health, the fact and degree of which are determined on the basis of the conclusion and in accordance with the requirements of MSEC.
The disability group is established in accordance with the requirements and on the basis of the conclusion of the MSEC, characterizes the degree of disability and determines the requirements for care, indications and contraindications of a medical nature. The requirements of MSEC provide for the establishment of three groups of disability.
The first group of disability involves social insufficiency due to a health disorder with a persistent, significantly pronounced disorder of body functions due to diseases, the consequences of injuries or defects, leading to a pronounced limitation of life.
The second group of disability is defined as social insufficiency due to a health disorder with a persistent pronounced disorder of body functions due to diseases, the consequences of injuries or defects, leading to a pronounced limitation of life.
And the third group of disability is allocated in relation to social insufficiency due to a health disorder with a persistent slight or moderately pronounced disorder of body functions due to diseases, the consequences of injuries or defects, leading to a mild or moderately severe limitation of life.
When insuring children against accidents and illnesses, a certain specificity in the formation of insurance protection is manifested in the fact that children do not yet have the ability to work and the scale of disability groups is equally inapplicable to them. With regard to children, we can only talk about such risks that can be insured, such as various injuries (bodily injuries), as well as the very fact of assigning a disability without reference to a specific group.
Thus, current trends in the structuring of insurance coverage for accident and illness insurance are reduced to the fact that such standard coverage applies to classic, traditional manifestations of an accident. However, extended coverage may also include coverage for:
a) sudden illnesses equating to accidents, as well as
b) cases of disability (temporary, permanent, professional) or for various groups of disability (if the insurer continues to adhere to the Russian scale for assessing the degree of loss of a citizen's health).
Often, insurers establish a clearer linkage of diseases covered by the conditions of accident insurance to the very fact of an accident, which seems logical, given that we are talking specifically about accident insurance. This means that the insurer provides insurance coverage against an accident, as well as those diseases that manifest themselves as a result of an accident, and that is why they are characterized by the same criteria of suddenness as an actual accident.
The contract is concluded on the basis of a written application of the insured, which also contains questions about all the conditions and circumstances that are essential for taking the risk for insurance, and the risk selection criteria are subjective risks, profession, age and health of the insured, etc. The insurance contract is concluded on the basis of insured statements.
Occupation until recently remained the most important criterion for risk selection, and other criteria, such as, for example, participation in certain sports, supplemented it.
Thus, groups of insurers (insured persons) according to this criterion are divided into the following categories:
a) 1st category - sedentary professions with rare movements; professions related to the control of physical and manual labor; low-risk factory workers (eg, real estate agent, insurance agent, kindergarten teacher, neurologist, ophthalmologist, archivist, architect, choreographer, geographer, etc.);
b) 2nd category - manual workers in workshops and industrial enterprises (without the use of mechanical means); manual workers (without the use of explosive materials and traumatic equipment) (for example, a plumber, an agronomist, a lawyer, an actor, a psychiatrist, a physiotherapist, a biochemist, a city transport driver, etc.);
c) 3rd category - professions associated with physical labor or the use of mechanical means, explosive materials; persons working at a height of more than 5 meters (for example, a ballet dancer, an archaeologist, an ambulance doctor, an anesthesiologist-resuscitator, an auto mechanic, a veterinarian, a cutter, an installer, an assembler, an antenna fitter, etc.);
d) 4th category - high-risk professions (for example, a race car driver / motorcycle racer, a military man, a diver, a lumberjack, a geologist, a policeman, a stuntman, a firefighter, etc.).
In recent times, however, the importance of the profession/occupation criterion has somewhat diminished, mainly due to improvements in the means of protection and prevention against accidents in the workplace.
Currently, more and more attention is paid to the lifestyle of the insured, his habits, because with the growth of opportunities for extreme sports or the availability of buying sports cars, an increasing number of people acquire certain habits or addictions that increase the likelihood of an accident.
Age is a rather difficult risk selection criterion, since, on the one hand, the risk of an accident increases with age, and the recovery process after it takes longer, but, on the other hand, older age is more cautious. Age is taken into account by the underwriter when determining the sum insured, which is calculated as the product of the insured person's annual income by a coefficient corresponding to his age. As a rule, the coefficient decreases with aging. For example, for people under 25 years old, it can be 18, and for people over 65, it can be 421.
Health appears to be an important criterion for risk selection, as it may involve a medical examination. Factors that contribute to the acquisition of new diseases, increase the cost of treatment, prolong the recovery period, etc. are taken into account.
Accident and illness insurance means that the insurer covers the risk that the insured will be physically injured as a result of an accident, and not natural causes. Under natural causes in relation to this species insurance refers to sudden onset of acute illnesses (diseases) that caused death or disability. Based on this, accident and illness insurance can be defined as a set of types of personal insurance that provide for the obligations of the insurer for insurance payments in a fixed amount or in the amount of partial or full compensation for the lost income of the insured caused by the occurrence of an insured event.
An insurance contract may be concluded with insurance coverage in the event of the following events:
a) death as a result of an accident or illness, quite often also referred to as the sudden death of the insured (insured person);
b) permanent or partial complete loss of the general working capacity of the insured person as a result of an accident or illness;
c) temporary disability (illness) of the policyholder (insured person) as a result of an accident or illness;
d) disability of the policyholder (insured person) as a result of an accident or illness.

Chernova G. V., Kudryavtseva A. A., Khovaniv N. V., Personal insurance underwriting. - St. Petersburg: Insurance Institute, 1996, p. 47-48.

An insurance contract may be concluded in the event of the occurrence of one or more of the events listed above.
Sudden death of the insured person, permanent or partial complete loss of general ability to work, temporary disability (illness), disability of the insured (insured person) are recognized as insured events if:
a) these events were a direct consequence of an accident or illness that occurred during the period of validity of the insurance contract;
b) these events occurred within 1 (one) year from the date of the accident (illness) regardless of the validity of the insurance contract at the time of the occurrence of these events;
c) these events and the accident (illness) are confirmed by documents issued by the competent authorities in the manner prescribed by law (medical institutions, MSEK, registry office, court, etc.).
As a rule, the insurance contract and (or) insurance rules also contain exceptions. For example, the most common exceptions to the accident and health insurance rules are as follows: events caused by occupational or general diseases that occurred before the conclusion of the insurance contract, or occurred as a result of an intentional crime committed by the insured or the beneficiary that caused the occurrence of the event; the presence of the insured at the time of the accident in a state of alcoholic, narcotic or toxic intoxication; intentional infliction of bodily harm to the insured, etc.
Also excluded from the insurance coverage are accidents resulting from war, intervention, armed clashes, other similar or equivalent events (regardless of whether war was declared or not), civil war, rebellion, putsch, other illegal seizure of power, rebellion , other popular unrest, as well as another similar event related to the use of weapons, ammunition, other tools that can cause harm to health; action of nuclear energy in any form.
The standard exclusion from insurance coverage is also traumatic consequences and other manifestations of an accident resulting from:
a) the policyholder (the insured person) engages in various sports at a professional level, including competitions and training, as well as the following sports on an amateur basis: motor racing, any kind of equestrian sports, air sports, mountaineering, martial arts, scuba diving, shooting and so on.;
b) participation in air flights, with the exception of flights as a passenger of an air flight licensed for the carriage of passengers and operated by a pilot with the appropriate certificate, as well as direct participation in military maneuvers, exercises, testing of military equipment or other similar operations as a military or civil servant etc.
However, by agreement of the parties, fixed in the insurance contract, and if there is such coverage in the insurance rules, which are an integral part of the license for this type of insurance, this exemption may be included in the scope of the insurer's insurance liability for an additional insurance premium rate.
An individual insurance contract is concluded by an individual, and its effect applies to the insured, and may also apply to members of his family. Under a collective insurance contract, the insured is a legal entity, and the insured - individuals who are employees of the enterprise, in the life and health of which the insured has an insurable interest. Collective insurance contracts are concluded, as a rule, by employers in favor of their employees or by various unions, societies, associations (hunters' associations, trade unions, etc.) in favor of their members.
The insurance coverage for collective accident insurance is limited, as a rule, to the period of professional (official, social) activity, however, at the discretion of the insured, it may extend to a certain extent to the private life of the insured person.
Individual voluntary accident insurance may involve insurance protection for any period, in relation to any kind of activity, including human life, and in any territory (full accident insurance). It can be short-term, and in this form is rather an addition to other types of insurance, for example, accident insurance for the period of stay abroad (on a trip). In addition, it can be an additional option to other types of insurance carried out, as a rule, on an annual basis, for example, additional accident insurance for the driver and passengers of a motor vehicle in a comprehensive auto insurance policy.
Accident insurance is also the most common additional insurance coverage in various types of life insurance.
When insuring against accidents and illnesses, insurers use two approaches to building insurance coverage:
a) the first one is based on the principles of insurance against all risks, while the types of insured events covered (injury, death as a result of an accident, temporary disability, etc.) are quite clearly named (identified), but without establishing the specific causes of such consequences, but with a list of exceptions (withdrawals);
b) the second follows the principle of insurance on the basis of named perils, while the policy (insurance rules) contains a detailed list of all events that are recognized or not recognized as insured and, accordingly, are included in or excluded from insurance coverage. For example, injuries and other bodily injury or damage to health as a result of:

amateur sports;
saving people or property, permissible self-defense;
attacks or attempts;
diving, drowning;
emergency release of gas or steam;
electric shock;
ingress of a foreign body into the respiratory tract;
burns and other injuries;
bites of animals, snakes, stinging insects, etc.

In the event of death as a result of an accident, the insurer shall pay to the beneficiary specified in the insurance policy or to the heirs of the policyholder (insured person) the established sum insured. In case of injuries, bodily injuries, other damages to health, the payment of insurance coverage is carried out, as a rule, on the basis of tables of insurance payments. These tables reflect the degree of disability based on the complete loss or loss (decrease) of the functionality of various organs, as a rule, based on the statistics of the insurance company.
Benefit tables can either be very detailed and cover various aspects and manifestations of an accident. Thus, the classification of the consequences, and with them the amount of insurance payments (as a percentage of the sum insured established under the insurance contract) can be carried out in relation to a body part or organ. For example, stand out:

Then a deeper classification is carried out on the basis of the allocation of a single injury or other consequences of an accident. For example, a) for the central and peripheral nervous system:

	Type of injury (consequences)	Payout amount, %
1.	Skull fracture:
A)	fracture of the outer plate of the bones of the arch	5
B)	vault fracture	15
V)	base fracture	20
G)	vault and base fracture For open fractures, an additional 5% is paid	25
2.	Intracranial traumatic hemorrhage:
A)	subarachnoid	15
b)	epidural hematoma	20
V)	subdural hematoma	25
3.	Crushing of the substance of the brain	50
4.	brain contusion	10
5.	Concussion that required hospital treatment for at least 10 days	5
6.	Damage to the spinal cord at any level, as well as the "cauda equina":
A)	shake	.5
b)	injury	10
V)	partial rupture, compression, poliomyelitis	60
G)	complete break	100
7.	Peripheral cranial nerve injury	10

Damage to the cervical, brachial, lumbar, sacral plexuses and their nerves, damage to the plexuses:

traumatic plexitis

In addition, there are tables of insurance payments for injuries, injuries and other health disorders, manifested in the form of temporary disability and in the form of permanent disability. So, if the above example can be attributed to the type of temporary disability, then the following can be cited as an example of the Table of insurance payments for permanent disability.

Permanent total disability

Complete loss of vision in both eyes 100%
Complete incurable mental insanity 100%
Loss of both arms or both hands 100%
Complete bilateral deafness due to trauma 100%
Removal of the lower jaw 100%
Loss of speech 100%
Loss of one arm and one leg 100%
Loss of one arm and one foot 100%
Loss of one hand and one foot 100%
Loss of one hand and one leg 100%
Loss of both legs 100%
Loss of both feet 100%

Permanent partial disability

A. Head

Loss of the bones of the skull

at least 6 sq. cm
from 3 to 6 sq. cm
less than 3 sq. cm

Partial removal of the lower jaw, ascending dissection of the entire or half of the maxillary bone
Loss of one eye
Complete unilateral deafness

b. upper limbs

Loss of one arm or hand of one arm
Significant loss of arm bones (permanent and incurable damage)

19. Complete paralysis of the upper limb

(terminal nerve damage)	65%	55%
20. Complete paralysis of the circumflex nerve	20%	15%
21. Ankylosis of the shoulder joint	40%	30%
22. Ankylosis of the elbow joint
in a favorable position (15 degrees near the right angle) 25%		20%
in an unfavorable position	40%	35%
23. Extensive bone loss of the forearm
(permanent and incurable damage)	40%	30%
24. Complete paralysis of the median nerve	45%	35%
25. Complete radial nerve palsy at the torsion cradle	40%	35%
26. Complete paralysis of the radial nerve of the forearm	30%	25%
27. Complete paralysis of the radial nerve of the arm	20%	15%
28. Complete paralysis of the cubital nerve	30%	25%
29. Ankylosis of the wrist joint in a favorable position
(arm held straight and palm down)	20%	15%
30. Ankylosis of the wrist joint in an unfavorable
position (hand in a bent position or unnatural
stretching or palm up)	30%	20%
31. Complete loss of the thumb	20%	15%
32. Partial loss of the thumb at the level
nail phalanx	10%	5%
33. Complete ankylosis of the thumb	20%	15%
34. Complete amputation of the index finger	15%	10%
35. Amputation of two phalanges of the index finger	10%	8%
36. Amputation of the nail phalanx of the index finger	5%	3%
37. Simultaneous amputation of the thumb and index
finger of the hand	35%	25%
38. Amputation of the thumb and other,
not index finger	25%	20%
39. Amputation of two fingers
(except thumb and index finger)	12%	8%
40. Amputation of three fingers (except for the thumb
and index)	20%	15%
41. Amputation of four fingers (including
thumb)	15%	10%
42. Amputation of four fingers (excluding the thumb)	40%	35%
43. Amputation of the middle finger	10%	8%
44. Amputation of the ring finger or little finger	7%	3%
V. lower limbs
45. Amputation of the femur (upper half)	60%
46. Amputation of the femur (lower half)
and shins	50%
47. Complete loss of the foot (tibio-tarsal dissection)	45%
48. Partial loss of the foot (sub-ankle-bone disarticulation)	40%
49. Partial loss of foot (medio-tarsal disarticulation)	35%
50. Partial loss of foot (tarso-metatarsal disarticulation)	30%

Complete paralysis of the lower limb

(terminal nerve damage) 60%

Complete paralysis of the external popliticsciatic nerve 30%
Complete paralysis of the internal popliticsciatic nerve 20%
Complete paralysis of two nerves (poplitic sciatic external

and internal) 40%

Ankylosis of the thigh 40%
Ankylosis of the knee 20%
Loss of part of the femur or both bones of the lower leg (incurable condition) 60%
Loss of part of the patella bone with significant separation of fragments and severe difficulty in movement

when stretching the leg 40%

Loss of part of the patella bone while maintaining movement 20%
Shortening of the lower limb by more than 5 cm 30%
Shortening of the lower limb from 3 cm to 5 cm 20%
Shortening of the lower limb from 1 cm to 3 cm 10%
Complete amputation of all toes 25%
Amputation of four toes (including the big

finger) 20%

Amputation of four fingers 10%
Ankylosis of the big toe 10%
Amputation of two fingers 5%
Amputation of one toe (except for the big toe) 3%

Burn area (% of body surface)	Burn degree
Burn area (% of body surface)	I	II	IIIA	SB	IV
up to 5	1	5	10	13	15
5 to 10	3	10	15	17	20 .
11 to 20	5	15	20	25	35
from 21 to 30	7	20	25	45	55
from 31 to 40	10	25	30	70	75
from 41 to 50	20	30	40	85	90
from 51 to 60	25	35	50	95	95
from 61 to 70	30	45	60	100	100
from 71 to 80	40	55	70	100	100
from 81 to 90	60	70	80	100	100
over 90	80	90	95	100	100

At the same time, additional (special) payments are provided for burns of the respiratory tract (30% of the sum insured), burns of the head and (or) neck (from 5 to 20% of the sum insured), burn disease (burn shock) (additional 20% from the sum insured), etc.

The amount of insurance coverage payments on the occasion of assigning a certain disability group is calculated by multiplying the sum insured established in the insurance contract by a coefficient according to the disability group, for example:
a) the first group of disability - with a coefficient of 70 - 90%, sometimes with the first group of disability the insurance amount is paid in full;
b) the second disability group - with a coefficient of 50 - 70% (within the second disability group, the so-called "working" and "non-working" are also distinguished

groups, that is, the one in which certain types of labor activity are allowed, and the one in which this is unacceptable);
c) the third group of disability with a coefficient of 25-50%.
This method is based on data on the percentage of general disability, which is calculated by medical institutions or medical expert commissions (MSEC). According to the way MSEC assigns a particular disability group to the insured (insured person), the insurance company calculates the amount of insurance coverage to be paid.
The second method is based on the category of "incapacity for work". For various categories of disability, tables of insurance payments are also used (examples are given above). For multiple indicators of disability, the amount of the benefit is determined by adding the coefficients shown in the benefit tables, however, the total amount of the benefit cannot exceed 100% of the disability for the body that includes the lost members.
In case of temporary disability (illness), such a form of insurance coverage as a daily allowance for the period of treatment and rehabilitation may be provided, however, in this case, the insurer seeks to limit not only the amount of the daily allowance (established in proportion to the sum insured), but also for the period for which the insurer will pay insurance coverage. As the maximum value of the benefit, it is customary to consider the size of the average daily labor income of the insured (insured person).
In addition, such insurance coverage is usually provided with a temporary deductible, expressed in the number of first days of incapacity for work for which insurance coverage is not paid (it is usually the first seven days).
Insurance coverage may also provide additional coverage for various categories of expenses related to and (or) directly arising from an accident, for example:
a) medical expenses necessary for the treatment of the consequences of an accident (expenses for emergency medical care, hospitalization, outpatient treatment, medicines, care, etc.);
b) transportation costs (if it is necessary to transport the insured person to a medical institution, home, etc.);
c) expenses for prosthetics, cosmetic surgery, rehabilitation (sanatorium) treatment;
d) expenses related to the transportation of the body of the policyholder (insured person) to the place where the insured person permanently resided (repatriation of the body);
e) expenses associated with the stay of a family member with the insured (insured person), etc.
The amount of payment of insurance coverage, as a rule, is set in the form of a percentage limit (liability limit) of the sum insured established under the insurance contract. So, if the sum insured for the basic insurance coverage is set at 100 units, then the general or individual limits of liability for various categories of expenses (additional coverage) can be set at a level not exceeding 15% of the sum insured established for the basic insurance coverage.
The general practice of insurance companies providing insurance against accidents and diseases, when determining the amount of insurance payments, is predetermined by the fact that

whether the insurer establishes a single sum insured (usually in the event of death as a result of an accident), on the basis of which the amount of insurance coverage is calculated, or the insurer uses different sums insured to determine each type of insurance coverage provided under the policy.
Foreign Insurance companies offer the two most common options for insurance coverage, namely: the one that provides for the payment of insurance coverage within a single sum insured, established separately for each risk, and the one that involves the provision of insurance coverage within a single sum insured, established as a whole under the insurance policy .
Accident and illness insurance has established itself in Russia as a fairly common and popular insurance, both in the form of individual and collective insurance. Of course, the motivation for concluding such insurance contracts in different periods of development insurance market was different (from financial planning, tax optimization to a real desire to provide employees with adequate social and economic protection). The past and upcoming changes in tax, civil, social legislation suggest that this type of insurance activity will be one of the most popular, inexpensive and dynamic types of insurance.
Control questions to Chapter 25:

What is the socio-economic significance of accident and illness insurance?
In what forms is it possible to carry out insurance against accidents and illnesses? Give examples.
Who can act as a beneficiary under an accident and illness insurance contract?
Describe the concept of "accident" in the conditions of insurance, reflect its main features and characteristics.
What are the features of the formation of insurance coverage in insurance against accidents and illnesses? Give examples of options (models) of basic and additional coverage in accident and illness insurance.
What are the main criteria for underwriting risks associated with accident and health insurance.
What are the features of establishing sums insured in accident and illness insurance?

Requirements and conditions applicable to the insurance of civil servants, heads of district administrations and municipal employees of a group of leading positions in the municipal service

1. The total amount of funds provided in the budget of the city of Moscow in 2008 for the insurance of civil servants is 23 million rubles.

2. Estimated number of insured people is 16868 people.

3. Equality of insurance payments is ensured for all insured persons in similar insurance cases.

4. A daily round-the-clock operation of the insurance policy is provided without time withdrawal.

5. Insured events include:

Death for any reason;

Prolonged disability resulting from illness, injury and mutilation;

Establishment of disability.

6. Withdrawal from insured events is determined by the insurance company according to the standard list.

7. Insurance indemnity must be received by the insured or other third party after 3 days from the date of receipt by the insurance company of a document confirming the occurrence of an insured event and duly certified.

Insurance companies "SOGAZ" and "Yugoriya" won the competition for the right to voluntary medical insurance (VHI) 3.874 thousand civil servants of the Tyumen region and government employees who are not civil servants. This company also operates in the Kostroma, Tver, Novosibirsk regions, as well as in the Krasnoyarsk Territory.

As part of the tender for the first lot, it was supposed to insure 2,098 thousand state civil servants of regional authorities, for the second - 1.3 thousand retired civil servants and 476 employees of government bodies who are not civil servants. 43.9 million rubles were allocated for this insurance from the regional budget. Yugoria was declared the winner in the first lot, and SOGAZ in the second lot. In addition to them, AlfaStrakhovanie, MAKS, NASTA, ROSNO and SG UralSib participated in the competition. Yugoria's message, circulated on July 5, states that the company will receive about 33 million rubles for its services. premiums.

The Moscow insurance company has won an open competition of the Moscow Committee for the organization and holding of competitions and auctions (tender committee) for the insurance of state and municipal employees of Moscow. The total cost of the state contract on the terms of the competition is 30.7 million rubles.

In addition to MSK, such insurance companies as Akviko, Avest-Classic, RESO-Garantiya, Rosgorstrakh-Stolitsa and Rosmedstarakh took part in the competition. One of the factors that determined the victory of MSC in the competition was the company's significant experience in the implementation of city accident insurance programs for civil servants. MSC has already won three times in similar competitions held in Moscow. To date, more than 21,000 Moscow employees are covered by insurance under this program. At the same time, insurance coverage is paid in cases of death, disability and temporary disability, which occurred not only as a result of accidents, but also in case of illness, which greatly increases the effectiveness of the insurance protection offered by MSK. . The shareholders of MSK are the Government of Moscow (51%) and the Bank of Moscow (49%). MSK has licenses for 84 types of insurance and the right to engage in reinsurance activities. According to the results of 9 months of the current year, IIC collected 727.3 million rubles of insurance premium, which is 2.2 times higher than in 2003. The total amount of the premium collected by the regional network of MSCs for 9 months amounted to 214.5 million rubles, which is 2 times more than for the whole of 2003.

The insurance group "Admiral" won the competition for the right to compulsory motor third party liability insurance, which was held by the Administration of the Rostov Region in relation to vehicles of state institutions subordinate to it. As the ASN was informed in the press service of the Insurance Group, the estimated amount of contracts for vehicle insurance will be 2,290,500 rubles.

The winner of the tender was determined according to the following criteria: the availability of the necessary qualifications, financial resources, transport and equipment necessary for the implementation of the contract, as well as experience and positive reputation. An important factor for the Customer was the fact that the insurance company had a wide branch network, since the Administration's cars often travel outside the Southern region.

Under the terms of the tender, within 20 days, an agreement (framework agreement) will be signed between Admiral and the Administration and a state contract will be concluded. Then the Customer will submit applications for specific fleets, on the basis of which the insurance company will issue insurance policies. It should be noted that in 2008 the Insurance Group won tenders for insurance of civil servants against accidents and illnesses and concluded OSAGO agreements with all state authorities and state institutions of the Rostov region.

"Admiral" has been operating in the insurance market since 1992. Total authorized capital- 140.5 million rubles. For 9 months of 2004 the insurer collected 214,425 million rubles. premiums. The regional network of the group includes more than 25 branches and representative offices.

In 2009, IC ROSNO won the open tender for the right to conclude government contracts for the provision of personal insurance services for the government needs of the Moscow Region.

The competition was held by the Ministry of Finance of the Moscow Region in two lots: insurance of civil servants of the Moscow Region in case of harm to their life and health in connection with the performance of official duties and voluntary medical insurance of civil servants of the Moscow Region and their families.

As a result of winning the tender, ROSNO insured the life and health of 11,320 government employees of the Moscow Region and provided medical care to 22,333 employees and their families.

In addition to ROSNO, four insurance companies of the federal level also took part in the competition.

"Admiral" has been operating in the insurance market since 1992. The total authorized capital is 140.5 million rubles. For 9 months of 2004 the insurer collected 214,425 million rubles. premiums. The regional network of the group includes more than 25 branches and representative offices.

In 2009, IC ROSNO won the open tender for the right to conclude government contracts for the provision of personal insurance services for the government needs of the Moscow Region.

As a result of winning the tender, ROSNO insured the life and health of 11,320 government employees of the Moscow Region and provided medical care to 22,333 employees and their families.

In addition to ROSNO, four insurance companies of the federal level also took part in the competition.

1.2 Foreign experience insurance of civil servants on the example of Mexico

Mexican labor law also regulates, to a certain extent, the cases in which it is allowed to make “deductions or reductions wages employee” (Article 38). The size of all deductions cannot exceed 30% of wages, however, this restriction is not taken into account, “if deductions from wages are made at the direction of social insurance authorities or the court (clauses 3 and 4 of article 38). High-ranking or so-called responsible government officials are paid differently from other employees. They "in relation to wages and social security," says the Constitution of Mexico, "occupy a special position" (paragraph XIV of section "B" of article 123). How things stand in practice can be seen on the example of the current law in the country "On incentives and bonuses for civil servants of the Federal District and Federal Territories". Despite the requirement of Art. 10, which states that “all payments and awards specified in this law apply to all government officials, whatever their category and position”, this law mainly concerns additional material benefits provided to the administrative ruling elite. Yes, Art. 55 of the Law provides for monetary payments “for a valuable initiative or activity in the field of planning the organizational work of administrative bodies, in the field of legal technology, the supply system, for research work, discoveries”, etc.

From the above article it is clear that such activities are carried out for the most part by the elected bureaucratic elite of the country. Therefore, this law, in addition to honorary titles, diplomas, insignia, medals, provides for additional vacations, tuition fees at institutes or advanced training courses, as well as in foreign educational institutions, both for executives and for members of their families. In addition, these officials may receive bonuses in the amount of 15, 45 or even 180 days of wages (Articles 2 and 3 of the Law).

The Mexican government also uses other legal measures that are aimed, on the one hand, at improving the work of all government officials, and on the other, aim to increase the exploitation of ordinary workers public service. Thus, the intensification of the work of the latter is carried out with the help of the Rules “On the stimulation of the work of employees of the Federal Government” in force in the country. According to these rules, which are an organic part of the internal labor regulations (Regulations) of each state institution, an employee who has at least 10 times shown special or, as stated in Art. 21 of the Rules, "diligent" effort, which is understood as "an increase in labor productivity compared to a normal task by 1/5 part", receives the so-called "good score" ("la buena nota"). The presence of a "good score" entitles the employee to receive monetary compensation in the amount of one day's wages, which is noted in his service certificate. Along with this, the rules contain norms that aim to interest public service employees in observing labor discipline, official punctuality, etc. Therefore, an employee can be awarded a “good score” for regular presence at work for a month or the absence of sanctions for distraction from work, for service performance, regular attendance during 15 days of service, the absence of omissions at work, or simply for strict adherence to labor regulations (Articles 10, 11 of the Rules). A civil servant who has received three "good points" is entitled to one day of additional rest (Article 13). Incentive measures are also cash payments determined by the amount of wages and issued for compliance with certain requirements of the internal labor regulations for 6 months (Articles 13-15 of the Rules).

Federal legislation specifically regulates the social insurance of civil servants, the amount of security for which is strictly differentiated depending on the conditions for the onset of disability and seniority. Thus, legal regulation the work of civil servants in Mexico is largely determined legal status civil servants on the administrative-hierarchical ladder of the country and is carried out in strict accordance with the requirements that the Mexican bourgeoisie imposes both on individual employees of its state apparatus and on the activities of this apparatus as a whole.

CHAPTER 2. ANALYSIS OF MODERN TRENDS IN THE DEVELOPMENT OF THE INSURANCE MARKET IN RUSSIA

2.1 Overview of trends Russian market insurance services

In the first quarter of 2008 the insurance market continued its active development. Among the trends of the last quarter, the following main ones can be distinguished:

· further reduction in the number of insurance companies; active supervision activities to combat unscrupulous insurers;

Market structuring in connection with industry specialization;

Consolidation of companies maintaining high transaction activity M active formation and restructuring of insurance and financial groups;

· Gradual development of classical life insurance against the background of cleansing of the life insurance market; growth of unprofitability in certain sectors of general insurance.

According to the results of the 1st quarter of 2008, the number of insurance companies continues to decrease. As of March 31, they were registered in the State Register 842. This process, familiar to the market since 2002, is associated with the strengthening of control measures by the supervisory authority, the intensification of mergers and acquisitions of insurance organizations, as well as the growth of unprofitability in certain sectors of the insurance market against the backdrop of an imprudent policy of aggressive expansion of the market share of individual companies with increased competition, stimulated by the arrival of foreign insurers.

Accident insurance

In this type of insurance, payments are made when the insured loses health due to accidents and illnesses. Usually insurance protection It is also provided in case of death from the indicated causes. Insurance against accidents and illnesses is carried out on a mandatory and voluntary basis.

Compulsory insurance is fixed in relation to military personnel, officials of customs authorities, employees of the state tax service and some other categories of civil servants (compulsory state insurance). The legislation provides for mandatory personal insurance of passengers (tourists, sightseers) of air, rail, sea, inland waterway and road transport.

Compulsory state insurance of civil servants and other persons is financed from the budget. Compulsory personal insurance for passengers is paid by the citizens themselves.

Voluntary insurance from accidents is physical or legal entities in case of harm to the life and health of the insured or the insured person as a result of an accident. The contract may indicate the beneficiary as the recipient of the sum insured in the event of the death of the insured person.

An accident is understood as a one-time sudden impact of various external factors (physical, chemical, technical, etc.), the nature, time and place of which can be unambiguously determined, which occurred against the will of the insured person and led to bodily injury, impaired body functions of the insured face or death.

Accidents include the impact of the following factors: a natural phenomenon, an explosion, a burn, frostbite, drowning, the action of an electric current, a lightning strike, a sunstroke, an attack by intruders or animals, falling objects, accidental acute poisoning, various injuries received while driving, or when using mechanisms, machines, weapons, tools.

Unless otherwise established by the Rules (or the insurance contract), then accidents do not include: any form of acute, chronic and hereditary diseases, anaphylactic shock, infectious diseases, food poisoning (salmonellosis, dysentery, etc.).

Insurers may impose restrictions on insured persons by age, health status (disability, drug use, alcoholism, persistent nervous or mental disorders).

The object of insurance protection is the property interests of the insured person and the insured that do not contradict the law and are related to the life, health and ability to work of the insured person. The insured must have an interest in maintaining the health and ability to work of the insured.

An insured event will be accidents that occurred during the validity of the contract, in the territory of insurance. For example, insurance coverage may apply to insured events that occurred to the insured person at work and (or) at home, within a certain territory and a certain period of time.

The policyholder has the right to choose any insured event or a combination of them. Events (unless otherwise provided by law) that occurred as a result of:

Exposure to a nuclear explosion, radiation or radioactive contamination;

Military operations, maneuvers and other military events;

Civil war, popular unrest, strikes;

Committing or attempting to commit an intentional crime involving the insured person, policyholder or beneficiary;

The insured person being under the influence of alcohol, narcotic or toxic intoxication at the time of the accident, as well as as a result of the transfer of control vehicle a person under the influence of alcohol, narcotic or toxic intoxication

Suicide of the insured person or attempts to commit suicide during the first two years of the insurance contract;

An accident that occurred with the insured person in prison;

Death of the insured person, directly or indirectly caused by mental illness, if the accident that led to death occurred to the insured person who was mentally ill and was insane at the time of the accident.

The insurance contract is concluded in writing on the basis of an oral or written application of the insured, which indicates the expected insured risks and the sums insured for them, data on the insured person (age, gender, profession, etc.), information that is essential for determining the degree of risk in relation to the insured person.

Before the conclusion of the contract, the insurer has the right to conduct a preliminary medical examination of the person accepted for insurance in order to assess the state of his health.

If collective insurance is carried out, lists of insured persons are attached to the contract, and each insured person may be issued an individual insurance policy.

The sum insured is determined by agreement between the insurer and the policyholder. insurance premium for each type of insured event is established on the basis of the sum insured and the base rate, to which increasing and decreasing coefficients can be applied, determined by experts, depending on factors affecting the likelihood of an insured event (profession, working conditions, the presence of risks associated with the state of health of the insured person ). The total amount of the insurance premium is determined as the sum of insurance premiums for each of the insured events specified in the contract.

Upon the occurrence of an insured event, the policyholder is obliged to immediately inform the insurer about it, as well as contact the relevant services (ambulance, registry office, etc.)

Insurance payment is carried out by the insurer on the basis of the application of the insured (his representative) with the attachment of supporting documents and the insurance act drawn up by the insurer. Depending on the nature of the insured event, the application is also accompanied by: insurance policy, certificate medical institution, the conclusion of a medical and social examination, the conclusion of a forensic medical examination, a sick leave certificate, a death certificate and other necessary documents confirming the fact and circumstances of the accident. To draw up an insurance act, the insurer may, if necessary, make inquiries related to the insured event to law enforcement agencies and other institutions and organizations that have information about the circumstances of the accident.

The amount of insurance payment in connection with the onset of an injury to the insured person is determined as a percentage of the sum insured in accordance with the "Table of insurance payments in case of loss of general working capacity by the insured person as a result of an accident" on the basis of a certificate from a medical institution, as a rule, without examination of the insured person.

In case of temporary disability, the insurance payment is made in a certain amount, for example, 0.5 or 1% of the sum insured for this type of insurance for each day of disability, as a rule, the payment period is limited to 60-90 days per year.

In the event of a permanent disability, the insurance payment is made to the insured person in the following amounts: when the first disability group is established - 100% of the sum insured; the second group of disability - 75% of the sum insured; third disability group - 50% of the sum insured, unless otherwise provided by the Rules (contract) of insurance.

The insurance payment in connection with the death of the insured person is made in the amount of 100% of the sum insured for this type of insured event or to the beneficiary or heirs of the insured person.

Insurance for citizens has become commonplace. The latest innovation following the European fashion is health insurance for civil servants. Such a program allows the population to use the list of services that are not included in the CHI. For example, businesses are offered accident insurance for civil servants.

Features of VMI for civil servants

In honey. compulsory type insurance (abbreviated as CHI) includes a minimum list of medical and preventive services and simple operations (for example, surgical interventions in the heart or other organs are not included here).

Additionally, state-owned enterprises are provided VHI insurance civil servants. The service is a contractual agreement between an enterprise and a medical organization that obliges them to provide treatment or preventive measures to employees.

Financial side

Our company "EUROINS" provides services of voluntary health insurance, including health insurance for civil servants. The price of the insurance package depends on the medical institutions that provide treatment services, the choice of medicines, timing, etc. It is worth remembering that many medicines are imported, and their cost depends on the exchange rate. The total cost of VMI for civil servants depends on: